Fillable CITY OF MT. SHASTA EMPLOYMENT APPLICATION (City of Mt Shasta)

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CITY OF MT. SHASTA EMPLOYMENT APPLICATION (City of Mt Shasta)

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The CITY OF MT. SHASTA EMPLOYMENT APPLICATION (City of Mt Shasta) form is 5 pages long and contains:

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  • 12 check-boxes
  • 108 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Mt Shasta

BROWSE CITY OF MT SHASTA (CA) FORMS

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Page 1 of 5
CITY OF MT. SHASTA
305 N. Mt. Shasta Boulevard
Mt. Shasta, California 96067
(530) 926-7510 FAX (530) 926-1342
EMPLOYMENT APPLICATION
PERSONAL INFORMATION DATE __________________________
NAME ______________________________________________________________________________________
Last First Middle
ADDRESS ___________________________________________________________________________________
Street City State Zip
HOME PHONE (____)_______________ CELL (____)_____________ EMAIL __________________________
REFERRED BY _______________________________________________________________________________
Are you currently related to anyone working for the City of Mt. Shasta? Yes____ No ____
If yes, please provide name, your relationship, and the City Department where they work:
_____________________________________________________________________________________________
Name of Relative Relationship City Department
EMPLOYMENT INFORMATION
POSITION APPLIED FOR ______________________________________________________________________
DATE YOU CAN START ____________________________ SALARY DESIRED _________________________
ARE YOU CURRENTLY EMPLOYED? Yes______ No______
EDUCATION AND TRAINING
HIGH SCHOOL GRADUATE? Yes___ No ___ ____________________________________________________
Name of High School
__________________________________________________________________
Address
RECEIVED GED? Yes ___ No ___ ___________________________________________________
Name of Institution
__________________________________________________________________
Address
Page 2 of 5
EDUCATION AND TRAINING (Continued)
Name/Location of Trade or Vocational Schools, Colleges,
Universities, Apprentice or Training Programs Attended
List Degrees
Or Certificates
Earned
Graduated
Yes No
Major
If this position requires a specific license or certificate, please complete:
Certificate of Training or Professional Registration
License Or
Registration No.
Date Issued/Expires
If this position requires typing skills, please indicate speed: ______ WPM (Typing certificate may be required.)
COMPUTER SKILLS: List programs in which you are proficient.
Page 3 of 5
SUBJECTS OF SPECIAL STUDY, TRAINING, OR RESEARCH
ACTIVITIES (Civic, Athletic, etc.): Exclude organizations, the name or character of which indicates the race, creed,
sex, marital status, age, color, or national origin of its members.
FORMER EMPLOYERS List all periods of employment and unemployment starting with present employment
working backwards. Indicate any discharge or forced resignation. List periods of U.S. Military Service and previous
service with the City of Mt. Shasta regardless of when they occurred. List different positions with the same employer
separately. Give complete information. A RESUME DOES NOT SUBSTITUTE FOR THIS SECTION. If you need
more space you can attach additional pages.
From To
Title
Hours Worked
Per Week
Employer Name/Address
Duties of Position
Number of
Employees Supervised
Name/Title of Supervisor
Reason for Leaving?
Currently Employed? Yes No If yes, may we contact present employer? Yes No
If yes, phone number:
Page 4 of 5
FORMER EMPLOYERS (CONTINUED)
From To
Title
Hours Worked
Per Week
Employer Name/Address
Duties of Position
Number of
Employees Supervised
Name/Title of Supervisor
Reason for Leaving?
From To
Title
Hours Worked
Per Week
Employer Name/Address
Duties of Position
Number of
Employees Supervised
Name/Title of Supervisor
Reason for Leaving?
Page 5 of 5
FORMER EMPLOYERS (CONTINUED)
REFERENCES
Give the names and contact information of three persons not related to you, whom you have known at least one year.
Name
Address
Relationship
Number
of Years
Phone Number
Conditions of Employment
B
efore date of hire, applicant may be required to pass a physical examination and will be required to submit proof of U.S. Citizenship
or legal right to remain and work in the U.S., submit proof of age, and be fingerprinted.
P
lease insert any additional information in your application which you feel will help us in our evaluation of your qualifications.
Before you submit your application to the Human Resources Department, recheck your application to make sure that it is correct and
complete. Thank you for your interest in employment with the City of Mt. Shasta.
B
y signing, I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of
facts called for is cause for dismissal.
SIGNED ________________________________________________ DATE ______________________________
This application expires one year from the date it was signed by the applicant. G:\ Human Resources/Employment Application Master
From To
Title
Hours Worked
Per Week
Employer Name/Address
Duties of Position
Number of
Employees Supervised
Name/Title of Supervisor
Reason for Leaving?
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CITY OF MT. SHASTA EMPLOYMENT APPLICATION (City of Mt Shasta)

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Completed 14 July 2020

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